Provider Demographics
NPI:1245299387
Name:HENDERSON, MURDOC MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:MURDOC
Middle Name:MICHAEL
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N WILEY AVE
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845
Mailing Address - Country:US
Mailing Address - Phone:229-524-8489
Mailing Address - Fax:229-524-6237
Practice Address - Street 1:900 N WILEY AVE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845
Practice Address - Country:US
Practice Address - Phone:229-524-8489
Practice Address - Fax:229-524-6237
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049616207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264430400Medicaid
GA00894407BMedicaid
AL009972810Medicaid
16BBBQPMedicare ID - Type Unspecified
GA00894407BMedicaid